Mentally Ill and Locked Up In New York Nursing Homes

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Hundreds of patients released from state psychiatric hospitals in New York in recent years are being locked away on isolated floors of nursing homes, where they are barred from going outside on their own, have almost no contact with others and have little ability to contest their confinement, according to interviews with workers and experts and visits to the homes.

The Pataki administration approved the creation of the special units for the mentally ill in 1996, but has otherwise left them unregulated. The nursing homes generally lack mental health expertise, and have not sought licenses to operate locked floors.

As a result, some experts said, the administration was allowing the homes to violate state regulations governing the care of the mentally ill and in the process was depriving them of their civil rights.

The conditions in the locked units, which the administration authorized with no public notice, were uncovered in a four-month investigation by The New York Times. The investigation was based on multiple visits to the homes -- many are in New York City -- as well as more than 50 interviews with residents, relatives, workers and officials.

The units are in nursing homes that mainly care for the elderly. They are not part of the separate system of adult homes for the mentally ill, which were the focus of a series of articles in The Times earlier this year that detailed extensive neglect and malfeasance.

The units are just the latest development in the troubled evolution of New York's mental health network over the last half-century. As the state continues to empty out its costly psychiatric hospitals, it appears to be moving even further from what it says had been a fundamental goal: helping the mentally ill gain independence and self-sufficiency to live within a community.

The investigation of the nursing home units shows that the mentally ill residents -- many in their 30's and 40's and physically healthy -- often receive little in the way of rehabilitative therapy and are chiefly left to wander the halls or languish in their rooms. The residents are not violent and have not been involuntarily committed by a court.

Yet on the fourth floor of the New Surfside nursing home in Far Rockaway, Queens, about 50 mentally ill people are prevented from going outside by locked elevators and fire doors with alarms. Residents at the nearby Haven Manor nursing home are outfitted with electronic bracelets that trigger an alarm should they try to leave. And at the Woodmere nursing home in Nassau County, residents have broken windows in a desperate bid for freedom, workers said.

Gov. George E. Pataki would not comment for this article. Administration officials and a main operator of the homes disputed that the floors are technically locked. They said the units are merely secured, and thus do not legally require a special license. The officials said the units provided quality care and did not confine residents against their will.

Visits to the homes and interviews with workers and residents like Leonard Holloway indicated otherwise. Mr. Holloway, who is 48 and has schizophrenia, was not allowed outside Haven Manor until late last month, three months after arriving at the home and only after being visited by a reporter.

''You feel like you're in a -- like you're a prisoner in here,'' said Mr. Holloway, once a clerk at the main branch of the New York Public Library.

Tacked on the wall over his bed is evidence of what he has accomplished during his stay: three children's jigsaw puzzles that he put together during recreation time, all of outdoor scenes.

Many mental health advocates and lawyers were unaware of the units and voiced dismay when told of the restrictions.

''I have never heard of this type of facility in the 12-plus years that I have been doing this,'' said Tim Clune, managing attorney for Disability Advocates, a nonprofit legal office in Albany. ''I am very surprised that this exists, and that the state would allow this to exist. This is de facto involuntary commitment. These people's civil rights are being violated.''

Administration officials said they did not know exactly how many units were operating. The State Office of Mental Health estimated that at least a dozen existed, suggesting that as many as 1,000 mentally ill people lived in them. Yet the office, which was responsible for discharging the patients from the state psychiatric hospitals to the units, has chosen not to take a role in overseeing them or ensuring that residents receive proper care.

The administration's chief nursing home regulators, Dr. Antonia C. Novello, the state health commissioner, and Wayne Osten, a senior health official, said the units were appropriate and had been examined by officials during routine inspections of the homes. They said the units, which the department refers to as ''neurobiological units,'' did not need additional oversight or regulations.

''The residents can leave the units if they want,'' Mr. Osten said. ''From our standpoint, there are means of egress for the residents.''

Mr. Osten said it would be incorrect to call the units locked, explaining that while elevators were often ''keyed,'' as he described them, the fire doors were only alarmed.

But workers at five homes said in interviews that residents are told that under no circumstances are they permitted outside on their own. The workers said the floors were confined to prevent the mentally ill residents from mixing with elderly residents on other floors. The restrictions also allow the homes to avoid hiring more staff to keep track of the mentally ill residents, the workers said.

An aide to Benjamin Landa, who is a partner in four homes with units, said state officials knew about the restrictions imposed on residents, adding that health and mental health officials had repeatedly visited the homes. The aide, Frank Iannucci, said the residents agreed to the conditions before they were admitted.

''This is a voluntary program,'' Mr. Iannucci said. ''All the clients are told exactly what is on the unit.''

Legal experts like Mr. Clune dismissed that assertion, saying that psychiatric wards are sending the patients directly to the units and the patients have little say in the matter.

In addition, the residents have not been deemed by the state to be a danger to themselves or others, which is typically the legal standard used to keep someone in a locked hospital psychiatric ward. Because the units are not licensed as psychiatric facilities, the residents also do not have the legal protections guaranteed to patients committed to psychiatric wards: the right to a lawyer, and to a hearing to contest having their freedom taken away.

''I would like to go out, but they won't let me,'' said a New Surfside resident who is in his 40's. ''I'm trapped. And I didn't expect this.''

The Council and Regulation

The units were first developed in the mid-1990's by Mr. Landa, one of the city's most prominent nursing home operators, and his staff in conjunction with the administration.

Mr. Landa has been a major contributor to Governor Pataki's campaigns and was appointed by the governor to the State Public Health Council, which is essentially an arm of the State Health Department that helps regulate hospitals and nursing homes.

Mr. Landa is a partner in four nursing homes that have a total of 200 beds in the special units: New Surfside and Brookhaven in Far Rockaway; Meadow Park in Flushing, Queens; and Woodmere in Nassau County.

The State Public Health Council has opted not to require regulation of the units, which have since gone on to accept patients from the psychiatric wards of general hospitals as well. Regulations typically are intended to ensure that residents receive proper mental health services and that their rights are being protected.

Despite repeated requests, the Health Department would not provide information on Mr. Landa's activities on the council, or on whether he was involved in council deliberations on the units.

Mr. Landa would not be interviewed. In a statement, he said he had never sought to prevent the units from being regulated. ''To the contrary, such regulations would further validate the significance of these important programs,'' the statement said. ''Therefore, I would welcome such oversight.''

His aide, Mr. Iannucci, said the units provided a therapeutic environment where psychiatrists visit twice a week, and a social worker is there daily. Many residents do so well that within a year, they are discharged to residential facilities, he said.

He also described the elevators on the floors not as locked, but rather as ''key-operated.'' He added that residents who had been deemed stable enough are eventually allowed to come and go as they please.

In separate interviews, seven workers on the Landa units all said residents were never granted such privileges. ''No one can come and go as they please,'' said a New Surfside worker, who spoke on condition of anonymity. ''It's a locked unit. They are not allowed off.''

Pacing Near the Elevator

Multiple visits to several of the nursing home units in the city, as well as interviews with dozens of workers, residents and their families, revealed facilities that are generally orderly and clean, but very much reminiscent of old-style institutions.

Isolated on the units, some residents see access to the elevators as their only escape. That was apparent on a visit to New Surfside, when a glimpse of an elevator key was enough to transform the quiet pacing of one resident into a frantic dash down the hall.

''Going home? Going home?'' the man shouted as a worker unlocked the elevator to let a visitor out. The man tried to make it inside, but was blocked by the worker. The doors shut, the lock was reactivated and the resident went back to pacing.

Nearby, a young man, his stringy blond hair covered by a straw hat, rocked back and forth silently. Other residents sat motionless in their chairs in the television room, watching ''Access Hollywood'' or nodding off. A daily activities schedule hung on the wall. Most of the time was devoted to meals, smoking breaks or what was referred to as ''recreation.''

The homes provide some therapy, but interviews and visits showed that the residents are mostly idle. Workers said residents are allowed outside only if they are accompanied by an aide, typically a few times a week for less than a hour at a time. At some of the homes, residents can lose the privilege of being escorted outside if they are disruptive, workers and residents said.

''Generally, you will hear them complaining that they want to leave,'' said a Brookhaven worker, who spoke on condition of anonymity. ''There is not much for them to do. They are just basically locked down on that floor.''

At Haven Manor, the elevators are not locked, but workers prevent residents from leaving the floor without permission, and residents are often required to wear electronic bracelets. Haven Manor's operator, Daniel Cantor, did not respond to three messages seeking comment.

In interviews, some residents of the units said they did not mind being confined, while others did not seem lucid enough to be aware of the restrictions. But some were clearly bothered by them and said that being in the units made their mental illness worse.

''I like my freedom,'' said Peter Frange, a resident at Brookhaven. ''Everybody likes their freedom. This isn't healthy. We don't get enough fresh air.''

Mr. Frange, 44, implored a reporter to help him get discharged to the Ocean House adult home, where he once lived. The state has long rated Ocean House one of the worst adult homes in the city, and is moving to revoke its license.

Governor Pataki has often made the mental health budget a target for cuts. By transferring patients to nursing homes, the administration realizes sizable savings.

It costs Albany $120,000 annually to treat a patient in a state psychiatric hospital. Discharge that same person to a nursing home and the bill typically goes to Medicaid, half of which is covered by Washington (Albany splits the rest with localities). So a mentally ill resident of the New Surfside nursing home, for example, might cost the state roughly $20,000 annually.

There are now 4,300 beds in the state psychiatric system, down from 9,000 when Mr. Pataki took office in 1995.

Shifting the Burden

While moving the mentally ill from hospitals to nursing homes in New York and elsewhere is not a new idea, it had typically been handled much more haphazardly. In the 1970's and 1980's, as deinstitutionalization took hold across the nation, the mentally ill population in nursing homes soared as states sought to shift the burden of mental health costs to Washington and avoid creating new housing for the mentally ill.

After reports of abuse and mismanagement surfaced, the federal government responded with measures intended to restrict the flow. Ultimately, in 1987, Congress mandated that states screen potential residents to ensure that they were not being inappropriately placed in nursing homes.

Pataki aides said they were abiding by the federal rules.

Just as with the creation of the adult home system more than three decades ago, the nursing home units came about with no planning or involvement from outside mental health experts, according to officials.

Some advocacy groups warned that with the nursing home units, the state was in danger of repeating the mistakes that it made with the adult homes: placing the mentally ill in facilities that were not meant for them, in an effort to reduce the size of the psychiatric hospitals and save money.

One group, the Coalition of Institutionalized Aged and Disabled, which learned of the nursing home units only late last year, said that if residents were well enough to be discharged from psychiatric wards, it was blatantly illegal to continue to confine them in facilities that have little psychiatric expertise.

''These are the new adult homes in the making,'' said Geoff Lieberman, the coalition's executive director. ''Residents who are inappropriate for nursing homes are being admitted, sometimes under false pretenses.''

The state mental health commissioner, James L. Stone, denied that the creation of the units had anything to do with money. ''The goal is the most appropriate care in a less restrictive standing in the community,'' Mr. Stone said. ''Are we under some pressure to do this to cut costs? The answer to that is no.''

Mr. Stone called the units excellent long-term housing. ''They have met a real need for some people who have been languishing in our state hospitals for some time,'' he said.

Facilities for Mentally Ill

Among the facilities caring for the mentally ill in New York:

*Psychiatric wards -- In state hospitals and general hospitals. All elevators and doors are typically locked. Regulated by mental health officials. Patients kept in locked ward if deemed a danger.

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